Colorectal cancer (CRC) is the third most common cancer in the United States. Although CRC screening is recommended for individuals 50 years and older, screening completion rates are low. This can be attributed to provider and patient barriers. We developed an intervention to improve provider recommendation and patient screening among noncompliant male veterans in a 2-year randomized controlled trial and examined the relationship between participation and study outcomes among patients and providers. Overall, providers who attended intervention sessions recommended CRC screening during 64% of patient visits and providers who did not attend any intervention sessions recommended screening during 54% of visits (p < .01). Patients of providers who attended intervention sessions also were more likely to be screened (42% versus 29%, p < .05). The patient intervention did not have the desired impact. The subgroup of patients in the patient intervention was not more likely to complete CRC screening.
American Cancer Society. (2001). Cancer facts and figures, 2001. Atlanta, GA: American Cancer Society.
2.
American Cancer Society. (2005). Cancer facts and figures, 2005. Atlanta, GA: American Cancer Society.
3.
Anderson, L.M., & May, D.S. (1995). Has the use of cervical, breast, and colorectal cancer screening increased in the United States?American Journal of Public Health, 85, 840-842.
4.
Becker, D.M., Gomez, E.B., Kaiser, D.L., Yoshihasi, A., & Hodge, R.H., Jr. (1989). Improving preventive care at a medical clinic: How can the patient help? American Journal of Preventive Medicine, 5, 353-359.
5.
Beresford, S.A., Shannon, J., McLerran, D., & Thompson, B. (2000). Seattle 5-a-Day Work-Site Project: Process evaluation . Health Education & Behavior, 27, 213-222.
6.
Best, J.A. (1989). Intervention perspectives on school health promotion research. Health Education Quarterly, 16, 299-306.
7.
Centers for Disease Control and Prevention. ( 2000). 2000 BRFSS summary prevalence report. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.
8.
Centers for Disease Control and Prevention. ( 2003). Colorectal cancer test use among persons aged 50 years and older—United States, 2001. Morbidity & Mortality Weekly Report, 52, 193-196.
9.
Church, T.R., Yeazel, M.W., Jones, R.M., Kochevar, L.K., Watt, G.D., Mongin, S.J., et al. (2004). A randomized trial of direct mailing of fecal occult blood tests to increase colorectal cancer screening. Journal of theNational Cancer Institute, 96, 770-780.
10.
Cooper, G.S., Fortinsky, R.H., Hapke, R., & Landefeld, C.S. (1998). Factors associated with the use of flexible sigmoidoscopy as a screening test for the detection of colorectal carcinoma by primary care physicians. Cancer, 82, 1476-1481.
11.
Davis, T.C., Dolan, N., Ferreira, M.R., Tomori C., Green, K.W., Sipler, A.M., et al. (2001). The role of inadequate health literacy skills in colorectal cancer screening. Cancer Investigation , 19, 193-200.
12.
Debus, M. (1988). Handbook for excellence in focus group research . Washington, DC: Academy for Educational Development/Healthcom. Deming, W.E. (1993). The new economics for industry, government, education. Cambridge, MA: Massachusetts Institute of Technology, Center for Advanced Engineering Study.
Doak, L.G., Doak, C.C., & Meade, C.D. (1996). Strategies to improve cancer education materials . Oncology Nursing Forum, 23, 1305-1312.
15.
Dulai, G.S., Farmer, M.M., Ganz, P.A., Bernaards, C.A., Qi, K., Dietrich, A.J., et al. (2004). Primary care provider perceptions of barriers to and facilitators of colorectal cancer screening in a managed care setting . Cancer, 100, 1843-1852.
16.
Elder, J.P., McGraw, S.A., Stone, E.J., Reed, D.B., Harsha, D.W., Greene, T., et al. (1994). CATCH: Process evaluation of environmental factors and programs. Health Education Quarterly, Suppl, S107-127.
17.
Ferreira, M.R., Dolan, N.C., Fitzgibbon, M.L., Davis, T.C., Gorby, N., Ladewski, L., et al. (2005). Health care provider-directed intervention to increase colorectal cancer screening among veterans: Results of a randomized controlled trial. Journal ofClinical Oncology, 23, 1548-1554.
18.
Ferreira, M.R., Dolan, N.C., Fitzgibbon, M.L., Newlin, R., Davis, T.C., Rademaker, A.W., et al. (2004). An intervention to increase colorectal cancer screening among veterans: Rationale and study design. International Journal of Cancer Prevention, 1, 369-381.
19.
Finnegan, J.R., Jr. , Murray, D.M., Kurth, C., & McCarthy , P. (1989). Measuring and tracking education program implementation: The Minnesota Heart Health Program experience. Health Education Quarterly , 16, 77-90.
20.
Ganz, P.A., Farmer, M.M., Belman, M., Malin, J.L., Bastani, R., Kahn, K.L., et al. (2003). Improving colorectal cancer screening rates in a managed care health plan: Recruitment of provider organizations for a randomized effectiveness trial. Cancer Epidemiology, Biomarkers & Prevention, 12, 824-829.
21.
Gibsons, K.C., Bennett, C.L., Schmitt, B., Ferreira, M.R., Dolan, N.C., Rademaker, A., et al. (2002). Low literacy interventions for colorectal cancer screening. Paper presented at the National VA Oncology Symposium, 2002 Abstracts, Washington, D.C.
22.
Heflin, M.T., Oddone, E.Z., Pieper, C.F., Burchett, B.M., & Cohen, H.J. (2002). The effect of comorbid illness on receipt of cancer screening by older people. Journal of the American Geriatrics Society, 50, 1651-1658.
23.
Hoffman-Goetz, L., Breen, N.L., & Meissner, H. (1998). The impact of social class on the use of cancer screening within three racial/ ethnic groups in the United States. Ethnicity & Disease, 8, 43-51.
24.
Kazis, L.E., Ren, X.S., Lee, A., Skinner, K., Rogers, W., Clark, J., et al. (1999). Health status in VA patients: Results from the Veterans Health Study. American Journal of Medical Quality , 14, 28-38.
25.
Lytle, L.A., Davidann, B.Z., Bachman, K., Edmundson, E.W., Johnson, C.C., Reeds, J.N., et al. (1994). CATCH: Challenges of conducting process evaluation in a multicenter trial. Health Education Quarterly , Suppl, S129-142.
26.
Mandelson, M.T., Curry, S.J., Anderson, L.A., Nadel, M.R., Lee, N.C., Rutter, C.M., et al. (2000). Colorectal cancer screening participation by older women. American Journal of Preventive Medicine, 19, 149-154.
27.
McPhee, S.J., Richard, R.J., & Solkowitz, S.N. (1986). Performance of cancer screening in a university general internal medicine practice: Comparison with the 1980 American Cancer Society Guidelines. Journal of General Internal Medicine, 1, 275-281.
28.
Meade, C.D. (1996). Producing videotapes for cancer education: Methods and examples. Oncology Nursing Forum, 23, 837-846.
29.
Meade, C.D., McKinney, W.P., & Barnas, G.P. (1994). Educating patients with limited literacy skills: The effectiveness of printed and videotaped materials about colon cancer. American Journal of Public Health, 84, 119-121.
30.
Montano, D.E., Phillips, W.R., & Kasprzyk, D. (2000). Explaining physician rates of providing flexible sigmoidoscopy. Cancer Epidemiology, Biomarkers & Prevention , 9, 665-669.
31.
National Cancer Institute. (1996). Racial/ethnic patterns of cancer in the United States 1988-1992 (NIH Publication No. 96-4104). Bethesda, MD: National Cancer Institute.
32.
Ornstein, S.M., Garr, D.R., Jenkins, R.G., Rust, P.F., & Arnon, A. (1991). Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services. Journal of Family Practice, 32, 82-90.
33.
Pignone, M., Harris, R., & Kinsinger, L. (2000). Videotape-based decision aid for colon cancer screening. A randomized, controlled trial. Annals of Internal Medicine, 133, 761-769.
34.
Ries, L., Eisner, M., Kosary, C., Hankey, B., Miller, B., Clegg, L., et al. (2001). SEER cancer statistics review, 1973-1998 . Bethesda, MD: National Cancer Institute.
35.
Roetzheim, R.G., Christman, L.K., Jacobsen, P.B., Cantor, A.B., Schroeder, J., Abdulla, R., et al. (2004). A randomized controlled trial to increase cancer screening among attendees of community health centers. Annals ofFamily Medicine, 2, 294-300.
36.
Rosenstock, I.M. (1974). The Health Belief Model: Origins and correlates . Health Education Monograph, 2, 336-353.
37.
Rosenstock, I.M., Strecher, V.J., & Becker, M.H. (1988). Social learning theory and the Health Belief Model . Health Education Quarterly, 15, 175-183.
38.
Shortell, S.M., Bennett, C.L., & Byck, G.R. (1998). Assessing the impact of continuous quality improvement on clinical practice: What it will take to accelerate progress. Milbank Quarterly, 76, 593-624.
39.
Taylor, V., Lessler, D., Mertens, K., Tu, S.P., Hart, A., Chan, N., et al. (2003). Colorectal cancer screening among African Americans: The importance of physician recommendation. Journal of the National Medical Association, 95, 806-812.
40.
Turner, B.J., Day, S.C., & Borenstein, B. (1989). A controlled trial to improve delivery of preventive care: Physician or patient reminders? Journal of General Internal Medicine, 4, 403-409.
41.
Vernon, S.W. (1997). Participation in colorectal cancer screening: A review. Journal of theNational Cancer Institute, 89, 1406-1422.
